Establishment and validation of a nomogram model for postoperative surgical site infection after transforaminal lumbar interbody fusion: A retrospective observational study.

BACKGROUND: Surgical site infection is one of the serious complications of transforaminal lumbar interbody fusion surgery, and many factors affect its occurrence. METHODS: A total of 1,277 patients who underwent transforaminal lumbar interbody fusion between 2018 and 2021 were enrolled in this study. Subsequently, 1,277 patients were randomly assigned to a training cohort (N = 958) and a validation cohort (N = 319) in a 3:1 ratio. We developed a nomogram according to the results of binary logistic regression analysis in the training cohort. The nomogram's predictive accuracy and discriminative ability were evaluated by calibration curve and receiver operating characteristic analysis. Decision curve analysis was performed to estimate the clinical value of our nomogram. RESULTS: In univariate and multivariate analysis, smoking, diabetes, intraoperative blood loss, American Society of Anesthesiologists class ≥III, serum calcium, albumin, and serum glucose were identified as significant independent predictors. The nomogram was developed using these independent predictors, which showed good diagnostic accuracy for surgical site infection of the training and validation cohorts. The calibration curves for the 2 cohorts showed optimal agreement between nomogram prediction and actual observation. The decision curve analysis of the nomogram model showed the great clinical use of the nomogram. CONCLUSION: The nomogram based on smoking, diabetes, intraoperative blood loss, American Society of Anesthesiologists class, serum calcium, albumin, and serum glucose has the potential as a clinically useful predictive tool of surgical site infection after transforaminal lumbar interbody fusion surgery. It is helpful to visualize the risk factors of surgical site infection.

Comparison of a directional cement delivery device versus conventional device in unilateral percutaneous kyphoplasty for the therapy of osteoporotic thoracolumbar fracture in the elderly.

BACKGROUND: Percutaneous kyphoplasty (PKP) has been demonstrated to be effective in the treatment of osteoporotic vertebral compression fractures (OVCF). However, bilateral puncture techniques take more time to accept more X-ray radiation; some spinal surgeons apply unilateral puncture PKP, but the cement cannot be symmetrically distributed in the vertebral body, so we apply a directional bone cement delivery device that undergoes PKP through the unilateral pedicle puncture. This research aims to compare the clinical and radiological results of PKP via unilateral pedicle approach using a traditional bone cement delivery device and a directional bone cement delivery device and determine the value of a directional delivery device for the therapy of thoracolumbar compression fracture in the elderly. METHODS: We undertook a retrospective analysis of patients with single-level OVCF treated with unilateral pedicle puncture PKP from Jan 2018 to Jan 2020. Operation time, radiation exposure, bone cement injection volume, and the incidence of bone cement leakage were recorded for presentation, and the cement leakage and bone cement distribution were measured by X-ray and computed tomography scan. The patients were followed up postoperatively and were assessed mainly with regard to clinical and radiological outcomes. RESULTS: There was no significant difference in the operation time, radiation exposure time, and incidence of bone cement leakage between the two groups. A significant difference was observed in the volume of bone cement injection between the two groups. All patients in both groups had significantly less pain after the procedures, compared with their preoperative period pain. There were no significant differences in Visual Analogue Scale, the relative height of the vertebral body, Cobb angle, and Quality of Life Questionnaire of the European Foundation for Osteoporosis between the two groups at 1 week after PKP, significant difference was observed only 12 months after operation. CONCLUSION: Application of directional bone cement delivery device is safe and feasible, compared with the application of traditional bone cement delivery device, without prolonging the operative time, radiation exposure time, and the incidence of bone cement leakage. It has the advantages of good short- and medium-term effect, excellent bone cement distribution, and low incidence of kyphosis recurrence.

An In Vitro Biomechanical Study of the Ectopic Functional Reconstruction of the Transverse Ligament of Atlas.

OBJECTIVE: To evaluate the stability and function of the C1-C2 joint after ectopic functional reconstruction (EFR) of the C1 transverse ligament. METHODS: Eight human cadaveric cervical spines (C0-C4) were subjected to in vitro biomechanical test with moment control. Spine specimens were tested under the following conditions: 1) left intact; 2) destabilized by severing the transverse ligament of atlas; 3) after EFR of the transverse ligament. Range of motion was measured in flexion, extension, lateral bending, and axial rotation. RESULTS: Destabilization significantly increased range of motion in all directions compared with the intact status (P < 0.001). However, after EFR of the transverse ligament, range of motion in all directions was restored to the intact state. Meanwhile, coupling motions were reproduced in the axial rotation. CONCLUSIONS: EFR of the transverse ligament virtually recovers all the physiological functions of the native transverse ligament and might be a promising alternative for the treatment of anterior atlantoaxial dislocation. Further studies are warranted before clinical application of EFR of the transverse ligament.

Interpretable clinical visualization model for prediction of prognosis in osteosarcoma: a large cohort data study.

Background: Currently, the clinical prediction model for patients with osteosarcoma was almost developed from single-center data, lacking external validation. Due to their low reliability and low predictive power, there were few clinical applications. Our study aimed to set up a clinical prediction model with stronger predictive ability, credibility, and clinical application value for osteosarcoma. Methods: Clinical information related to osteosarcoma patients from 2010 to 2016 was collected in the SEER database and four different Chinese medical centers. Factors were screened using three models (full subset regression, univariate Cox, and LASSO) via minimum AIC and maximum AUC values in the SEER database. The model was selected by the strongest predictive power and visualized by three statistical methods: nomogram, web calculator, and decision tree. The model was further externally validated and evaluated for its clinical utility in data from four medical centers. Results: Eight predicting factors, namely, age, grade, laterality, stage M, surgery, bone metastases, lung metastases, and tumor size, were selected from the model based on the minimum AIC and maximum AUC value. The internal and external validation results showed that the model possessed good consistency. ROC curves revealed good predictive ability (AUC > 0.8 in both internal and external validation). The DCA results demonstrated that the model had an excellent clinical predicted utility in 3 years and 5 years for North American and Chinese patients. Conclusions: The clinical prediction model was built and visualized in this study, including a nomogram and a web calculator (https://dr-lee.shinyapps.io/osteosarcoma/), which indicated very good consistency, predictive power, and clinical application value.

Genistein Protects against Spinal Cord Injury in Mice by Inhibiting Neuroinflammation via TLR4-Mediated Microglial Polarization.

Objective: The present study was designed to study the effect of genistein on spinal cord injury (SCI) in mice and to explore its underlying mechanisms. Methods: We established SCI mouse model, and genistein was administered for treatment. We used the Basso, Beattie, and Bresnahan (BBB) exercise rating scale to evaluate exercise recovery, and the detection of spinal cord edema was done using the wet/dry weight method. Apoptosis was determined by TUNEL staining, and inflammation was evaluated by measuring inflammatory factors by an ELISA kit. The expression of M1 and M2 macrophage markers was determined using flow cytometry, and the expression of proteins was detected using immunoblotting. Results: Genistein treatment not only improved the BBB score but also reduced spinal cord edema in SCI mice. Genistein treatment reduced apoptosis by increasing Bcl2 protein expression and decreasing Bax and caspase 3 protein expression. It also reduced the expression of inflammatory cytokines (TNF-α, IL-1ß, IL-6, and IL-8) in the SCI area of SCI mice. Flow cytometry analysis indicated that genistein treatment significantly decreased the ratio of M1 macrophages (CD45+/Gr-1-/CD11b+/iNOS+) and increased the ratio of M2 macrophages (CD45+/Gr-1-/CD11b+/Arginase 1+) in the SCI area of SCI mice on the 28th day after being treated with genistein. We also found that genistein treatment significantly decreased the expression of TLR4, MyD88, and TRAF6 protein in the SCI area of SCI mice on 28th day after being treated with genistein. Conclusion: Our findings suggested that genistein exerted neuroprotective action by inhibiting neuroinflammation by promoting the activation of M2 macrophages, and its underlying mechanisms might be related to the inhibition of the TLR4-mediated MyD88-dependent signaling pathway.

Licochalcone B Induced Apoptosis and Autophagy in Osteosarcoma Tumor Cells via the Inactivation of PI3K/AKT/mTOR Pathway.

Licochalcone B (LicB) is a flavonoid derived from the Chinese medicinal herb Glycyrrhiza uralensis Fisch. Several previous studies have demonstrated the wide range of pharmacological activities shown by LicB. In this study, we investigated the anticancer effects of LicB in osteosarcoma (OS) tumor cells and its underlying mechanisms. According to the Cell Counting Kit-8 (CCK8) analysis and 5-ethynil-2'-deoxyuridine (EdU) staining results, we found that LicB suppresses OS cells (MG-63 and U2OS) growth depending on its concentration. Furthermore, flow cytometry and Western blot revealed that LicB promoted autophagy and apoptosis in OS cells in a dose-dependent manner. LicB treatment not only decreased the levels of Bcl-2, p62, Caspase-3, and Ki67 protein in MG-63 and U2OS cell lines but also increased the levels of Cleaved Caspase-3, Beclin1, Bax, Atg7, and LC3B. Mechanistically, LicB induced cell apoptosis by promoting the apoptosis-related cleavage of Caspase-3, while suppressing the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway to induce autophagy. The present work is the first to illustrate that LicB can serve as a potential drug candidate for tumor treatment owing to its ability to enhance autophagy and apoptosis, and suppress OS proliferation by inactivating the PI3K/AKT/mTOR pathway.

An RCT study comparing the clinical and radiological outcomes with the use of PLIF or TLIF after instrumented reduction in adult isthmic spondylolisthesis.

OBJECTIVE: We prospectively compared posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) used in adult isthmic spondylolisthesis (IS) after surgical reduction with pedicle screws. METHODS: Between January 2009 and December 2010, 66 adult patients with single-level IS were randomly assigned to two groups treated using the PLIF technique (PLIF group, n = 34) and the TLIF technique (TLIF group, n = 32). Both groups were followed up for an average of 30.5 months (range 24-48 months). Clinical outcomes were assessed using the visual analog scale (VAS), Oswestry disability index (ODI) and Japanese orthopedic association (JOA) scores. Radiographic outcomes included percentage of vertebral slippage, focal lordosis and disk height. Clinical and radiographic outcomes were compared between the two groups. RESULTS: The average operative time and blood loss during surgery were significantly more in PLIF group than in TLIF group. Spondylolisthesis, disk height and focal lordosis were significantly improved postoperatively in both groups. There was no obvious difference in clinical outcomes, as assessed using the VAS, ODI and JOA scores, and radiographic outcomes. In PLIF group, there were two cases of neuropathic pain after surgery. CONCLUSIONS: After instrumented reduction of adult IS, either PLIF or TLIF can provide good clinical and radiological outcomes. With a single cage, TLIF was superior to PLIF in terms of surgical time and blood loss, but these differences may not be clinically relevant.

[Clinical analysis of surgically treated cervical spondylotic myelopathy with erectile dysfunction].

OBJECTIVE: To investigate the recovery of sexual function of surgically treated male patients with cervical spondylotic myelopathy. METHODS: A prospective and a mean 16-month postoperative follow-up were conducted for 22 male patients surgically treated for cervical spondylotic myelopathy complicated by sexual dysfunction. Their neurologic scores were obtained by the Japanese Orthopedic Association (JOA) Scoring System, their sexual function assessed by the International Index of Erectile Function (IIEF), and their pre- and post-operative reflexogenic and psychogenic erection analyzed by comparison. RESULTS: Most of the patients experienced an obvious improvement in neurological function after the surgery, with a significantly higher JOA score than pre-operation ( P < 0.01). Compared with the preoperative rates of abnormal reflexogenic and psychogenic erection, 82% (18/22) and 18% (4/22) , the average IIEF score was elevated from preoperatively (9.90 +/- 2. 22) to postoperatively (20.89 +/- 3.89), with a statistically significant difference (P < 0.01). CONCLUSION: Cervical spondylotic myelopathy induces sexual as well as neurological dysfunction, mostly with abnormal psychogenic but normal reflexogenic erection. With neurological recovery, most of the patients may experience an improvement in their sexual function after surgery.